Forensic Histopathology

Introduction

Forensic Medicine is a unique field compared to other medical fields. One of the explicit roles of Forensic Medicine is to conduct postmortem examination. Postmortem examination is a procedure whereby a forensic pathology expert thoroughly examines a body to fulfill the needs of the investigation of death on death cases under the provisions of the Laws of Malaysia. Contrary to other medical procedures which are more incline to diagnostic, therapeutic, or prognostic approach, our discipline is more towards an investigation process. The basic goal of any forensic examination postmortem is to find the cause of death as required under section 328, Criminal Procedure Code. According to this section, the meaning of death is not just limited to the obvious cause of death could be determined from postmortem examination, but also covers all matters or findings that may help to shape the way of the death (manner of death). In other words, the concept of the death in medicolegal point of view is far more extensive and thorough than clinical death (clinical cause of death).

To meet these terms, a forensic postmortem examination needed to be carried out in full. Forensic postmortem examination is basically comprised of four components or stages:

Histopathology is a branch of pathology expertise that includes research and analysis of biological tissue at microscopic level to detect any disease or abnormality. In general, the field of histopathology expertise is comprised of:

Clinical / surgical histopathology, where the histopathological examination performed on tissue samples obtained from living patients in wards, clinics and operating theaters, and it is aimed at the diagnostic and prognostic level. It is a branch of pathology expertise. Its primary objective is to diagnose a patient for further treatments.

Forensic Histopathology, histopathological examination is performed on dead tissue samples obtained from postmortem examination, and it is aimed at investigation of a case. It is a subspecialty branch of forensic pathology. Its main objective is to help determine the cause of death and matters related to the death. Accordingly, microscopic analysis was carried out to meet the forensic investigation requirement rather than treating patients.

These two areas of histopathology are basically quite similar, utilizing the same processing techniques and relatively similar type of specimen. However, there are four differences noted between the two fields histopathology which are as stated below:

Types of expertise; clinical histopathology is a clinical investigation, whereas forensic histopathology is a medicolegal investigation.

The origins of tissue samples; clinical histopathology specimens comes from living patients, while forensic histopathology specimens comes from dead body.

The basic goal; forensic histopathology is aiming to investigate a case, while clinical histopathology is more towards treating a patient.

Importance of Forensic Histopathology

Forensic Histopathology warranties the quality of post-mortem examination because in an evidence-based medicine practiced in the present age, forensic postmortem examination is no longer limited to dissection or macroscopic examination alone, but should be carried out at the microscopic level as well. Studies on the street by de la Grandmaison et al. 2010 on the application of systematic histological examination, of 428 cases of post-mortem, findings show approximately 40% of cases didn’t show their death mechanism through macroscopic observation, yet can be identified by histological examination.

Forensic Histopathology also helps in completing the post-mortem report in concluding the cause of death, i.e.; in cases of sudden death. Many diseases related to sudden death can be explained, such as William Williams-Beuren syndrome or syndrome (WBS), which can cause sudden death in children and young adults in particular (Wessel et al 2004;. Krous et al 2008;. Suarez-Mier and Morentin 1999 Bird et.al 1996), especially related to anesthetic (Gupta et.al 2005) and Lethal leptospirosis (Weil Morbus).

It also provides additional information to further strengthen the cause of death. The study conducted by de la Grandmaison et al. 2010 showed that histological examination provides additional information on the health problems of the deceased prior to the death of about 49% of all cases.

Forensics community has so far agreed on the need to perform histological examination of post-mortem cases. Some authors argued that microscopic examination should be performed only if needed, but not as a routine procedure (Moline et al., 2007). Some concluded that there is a large difference between the macroscopic and microscopic findings in the forensic autopsy, which may lead to confusion. However, histology is an important feature which can assess the quality of postmortem examination, which can be used to verify, correct or refute the findings of the macroscopic (De la Grandmaison et al., 2010).

Applications of forensic histopathology in Malaysia

In line with the development of other branches of forensic medicine such as toxicology and forensic anthropology, the field of forensic histopathology should also be developed with the establishment of a forensic histopathology laboratory in every department of Forensic Medicine all over the country. With the establishment of a complete laboratory, it can be a great help in postmortem procedure, from the moment of sampling until the report making.

Forensic Histopathology Laboratory

Forensic Histopathology Laboratory comprises of various equipments which the following processes :